PubMed · 5141227
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G Williams. 1971. Kaiser: What is it? How does it work? Why does it work?. https://pubmed.ncbi.nlm.nih.gov/5141227/
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BACKGROUND AND PURPOSE: The use of back school as a treatment for low back pain is widespread, but determining the efficacy of this approach is complicated by variations in back schools and study methods across clinical trials. The purpose of this study was to conduct a meta-analysis to synthesize existing evidence on the efficacy of back school as either a primary intervention or a part of a comprehensive rehabilitation program for patients with low back pain. METHODS: The results of 19 prospective randomized controlled trials were evaluated. Quantitative reviewing procedures were used to calculate the effect sizes that compared patients receiving back school with those in a control or comparison group. Effect sizes were computed for 206 hypothesis tests involving 2,373 patients. RESULTS: The average effect size for comprehensive rehabilitation programs that included back school (d = 0.28) was larger than the average effect size for programs that offered back school as the primary intervention (d = -0.14). When effect sizes were stratified by program type and outcome, the comprehensive programs were superior to primary back school programs with respect to pain reduction, increased spinal mobility, and increased strength. Both types of programs showed reasonable success with education/compliance outcomes (d = 0.27-0.28). Lower effect sizes were found among the types of programs for disability and work/vocational outcomes (d < or = 0.20). CONCLUSIONS AND DISCUSSION: Back schools were most efficacious when coupled with a comprehensive rehabilitation program. Efficacy was supported for the treatment of pain and physical impairments and for education/compliance outcomes. Work/vocational and disability outcomes, however, were not improved substantially beyond control levels in comprehensive or primary back school programs. [Di Fabio RP. Efficacy of comprehensive rehabilitation programs and back school for patients with low back pain: a meta-analysis.
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A means-goals analysis requires a plan with some degree of distinctness, which is worked out beforehand and specifies reasonably clear goals and intended means. This article draws its material from a broadly designed strategy for organizational change that meets these criteria. A service division of Swedish Telecom underwent a program of comprehensive organizational change; major efforts were made to improve the occupational health of 300 telephone operators in manual service operations. Over a full three-year period, a number of specific problems were to be resolved. An independent research team evaluated the implementation of the program prospectively. The team followed an evaluation model in which stringent distinction was made between: (1) action areas, (2) intended specific means, (3) intended immediate goals, and (4) the longer-term favorable effects of achieving these immediate goals. In addition, an attempt was made to interpret and understand the findings of the means-goals evaluation by paying systematic attention to the implementation process and factors that might permit an understanding of the final outcomes of the program. Compared with other efforts to improve telephone operators' work conditions as reported in the research literature, this strategy for the promotion of change is broad and ambitious.